Fall 2017 New for 2018 2 Valparaiso University will be offering 2 medical plans for 2018 PPO plan slightly different plan design than 2017 High Deductible Health Plan HDHP with a Health Savings Account ID: 718128
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Slide1
2018 Benefits
Employee Information Sessions
Fall 2017Slide2
New for 2018!
2
Valparaiso University will be offering 2 medical plans for 2018!
PPO plan (slightly different plan design than 2017)
High Deductible Health Plan (HDHP) with a
Health Savings Account
(HSA). This will replace the HRA plan
The HDHP with HSA will have a higher deductible than the PPO plan, but once you have met the deductible, your in-network medical and prescription drug expenses will be paid in full by the University!
The medical insurance administrator is changing from UHC to
AnthemSlide3
2018 Plan Designs
3
2018 Plan
Options
PPO Plan
HSA Plan
Deductible
$2,000 / $4,000
$3,000 / $6,000
Out-of-Pocket
Maximum
(With Deductible)$4,000 / $8,000$3,000 / $6,000Coinsurance80%100%Primary Office Visit Copay$30DeductibleSpecialist Office Visit Copay$60DeductibleEmergency Room$250, then coinsuranceDeductiblePreventive Care100%100%Prescription (Tier 1-4)$10, $30, $50, $100DeductibleRx Out-of-Pocket Maximum OPM$3,000 / $6,000N/AHSA Contribution (Year)N/A$500 / $1,000Slide4
HSA, FSA, & HRA Comparison
4
HSA
Medical FSA
HRA
Who owns the account?
Employee
Employee
Employer
Who funds
the account?
Employee/Employer
Employer (repaid
by Employee)
EmployerWhen are funds available?As they are contributed1st day of the plan year1st day of the plan yearAre contributions tax free?Yes (typically payroll deducted)Yes (repaid via payroll deduction)N/AAre there funding limits?$3,450 Employee$6,900 Family$2,600Employer’s discretionCan funds rollover to the next year?Yes, unlimitedLimited to $500Employer’s discretionWho keeps the funds if the employee terminates?Employee
Employer
Employer
What expenses are qualified & tax free?
Medical, dental, & visionMedical, dental, and vision*Only medical expensesCan I earn interest on my balance?YesNoNoCan funds be use for Medicare expenses?Yes, Part B, C & DNoNo
*Employees cannot use FSA dollars on medical expenses if they are contributing to an HSA. Only dental and vision expenses would be qualified FSA expenses (limited purpose FSA)Slide5
What is an HSA?
Health Savings Account (HSA)
Tax advantage account used to cover health plan expenses
Employee owns the funds in the account - portable
Funds can be used tax-free to pay for current and future medical expenses
Contributions into the account are pre-tax (payroll deducted)
Qualified High Deductible Health Plan (HDHP)
Lower employee premiums
Caps risk on large medical expenses
Covers the same eligible expenses as all other plan options
HDHP + HSA
Promotes consumerism and controlled expenses
Aligns with the onsite clinic investment
Increased tax savings
Lower insurance premiums (pay yourself instead of the health plan)Provides post-retirement healthcare savings mechanismBest Quality?Best Price?5Slide6
Deductible
$
3,000 Individual
$
6,000 Family
Out-of-pocket Maximum
Office Visits
Emergency Room
Outpatient Services
Inpatient Services
Prescription Drugs
All medical claims are covered at 100% once the deductible is satisfied.
HSA funds can be used here to pay for qualified medical
e
xpenses, including expenses applied towards the deductible and out-of-pocket maximumTax free dollarsValparaiso University contribution of $500 or $1,000 in 2018Health Plan caps the maximum risk on ALL COVERED medical and Rx expenses after your deductible is satisfiedHSA Health PlanHow does an HSA work with the health plan?6Slide7
How Do You Pay Your Medical Expenses?
Member goes to doctor for medical service
Doctor submits remaining claim to
Anthem
Anthem processes
claim, determines out-of-pocket liability for member (copay, coinsurance, deductible)
Member receives EOB from
Anthem
Member
will need to verify services rendered, cost share, and balance owed
Provider will send invoice for outstanding balance
COPAY
PPO Plan
Traditional Plan members
will use personal funds to pay for their cost share
HSA Plan member can use HSA funds to pay for their cost share
7Slide8
How Do You Pay Your Rx Expenses?
8
COPAY
PPO Plan Members
Member goes to pharmacy for prescription
HSA Plan members can use HSA funds to pay for their cost shareSlide9
2018 HSA Contributions
HSA Banking Administrator: Centier BankNo opening or annual feesCompetitive interest rates on deposit fundsView account balances onlineDebit card and checks are available
2018 Maximum Annual Contribution*
Employee
$3,450
Employee
+ Spouse
$6,900
Employee + Child(ren)
$6,900
Family
$6,900
*
Annual maximums include all contributions (including University funds)*Additional $1,000 catch-up contribution is allowed for participants that are 55 or older9Slide10
Important Information About HSAs….
Balances remaining in an HSA at the end of the year roll over to the next yearNo limit to total balance in accountOnly funds available (deposited) in the account may be usedAmounts distributed which are not used to pay for qualified medical expenses are subject to income taxes and an additional 20% excise taxHealth Care FSA dollars cannot be used on medical expenses in conjunction with a HSA
OTC drugs are not considered qualified medical expenses without a prescriptionOnly medical expenses on the account holder or “tax dependent” are non-taxableNo excise tax penalty applies if distributions are made after an individual’s death, disability, or attaining age 65Account holder is responsible for ensuring that expenses paid from the account are qualified medical expenses
The account holder must keep adequate records concerning the use of the HSA (i.e. receipts, EOB’s, etc.) and file a Form 8889 as part of their annual tax filing10Slide11
2018 Employee Contributions
Per Paycheck
Medical
HSA
without
PWP Participation
Medical
HSA
with
1
PWP Participant
Medical HSA with 2 PWP ParticipantsMedical PPO without PWP ParticipationMedical PPO with 1 PWP ParticipantMedical PPO with 2 PWP ParticipantsDentalVisionEmployee Only< $30,000 per year$42.13$27.13--$57.68$42.68--$9.24$3.23Employee Only> $30,000+ per year
$76.12
$51.12
--
$96.68$71.68--$16.14$5.86Employee + Spouse$152.01$127.01$102.01
$185.34
$160.34
$135.34
$32.98
$9.94
Employee + Child(
ren
)
$124.51
$99.50
--
$157.84
$132.83
--
$32.98
$56.77*
$9.94
$15.13*
Family
$186.34
$161.34
$136.34
$243.16
$218.16
$193.16
$56.77
$15.13
11Slide12
Maggie is single and injures her hip on a ski vacation.
The injury requires surgery. The costs associated with her procedure total $60,000. Maggie also has 6 monthly follow-up visits with her orthopedic specialist for check-ups on her injury. What does Maggie pay?
PPO Plan
Deductible
$2,000
Coinsurance
(20% to
OOPM)
$2,000
Office Visits $0
Maggie’s
Cost
$4,000Maggie’s Premium* $1,864Maggie’s Total Cost $5,864Maggie could also use her own additional pre-tax HSA funds to pay the claims cost.HSA Plan Deductible $3,000Coinsurance (0% to OOPM) $0Office Visits $0Maggie’s Cost $3,000VU HSA Contribution ($500)Maggie’s Premium* $1,329Maggie’s Total Cost $3,829PPO vs. HSA Claim Example 1*Assumes employee participates in PWP12Slide13
Libby is married and has 4 kids. During the year, she had 6 visits to the pediatrician ($175 each) and had to fill 9 Tier 2, brand prescriptions ($100 each).
She and her husband Jack went to the doctor 4 times during the year and filled 4 prescriptions, all through the OurHealth Clinic. How much did they spend during the year?
PPO Plan
6 x $25 OV copay $150
Tier 2 Rx (9 x $30) $270
4 x OV (Clinic) $0
4 x Rx (Clinic) $0
Libby’s Cost $420
Libby’s
Premium
*
$5,022
Libby’s Total Cost $5,442HSA Plan 6 x $175 OV $1,050Tier 2 Rx (9 x $100) $9004 x OV (Clinic) $04 x Rx (Clinic) $0Libby’s Cost $1,950VU HSA Contribution ($1,000)Libby’s Premium* $3,545Libby’s Total Cost $4,495Libby could also use additional pre-tax HSA funds to pay the claims cost.PPO vs. HSA Claim Example 2*Assumes both employee and spouse participate in the PWP13Slide14
Not sure which plan is right for you?
Or do you want to learn more? Try using the ALEX tool!ALEX will ask you simple questions about your typical medical and Rx expenses, and then Alex will use your answers to recommend a health plan for you Learn more about HSAs and FSAs in “Tax Savings”
We have computers setup with the ALEX tool for you to try out, or you could also use the tool outside of work. The link for the tool is: https://www.myalex.com/Valparaiso-University/2017
14Slide15
Consumer Resources
Compare cost and quality of care
Figure out how much you’ll pay for care – before stepping foot in a doctor’s office.
Use anthem.com or our mobile app to:
Check what doctors, hospitals and health care professionals charge for procedures.
Search by area, type of procedure or treatment,
or doctor name.
Compare doctors and hospitals based on quality
of care measures.
15Slide16
Consumer Resources
To see an explanation of benefits (EOB), log in and go to Recent Claims and choose View EOB for a claim
.Instead of getting EOBs in the mail, you can see them 24/7 on our website. Just sign up to receive EOBs online, under your Profile section.
Find out if a claim was paid or if you owe anything
16Slide17
Consumer Resources
Save on health-related products and services, including:Gym membershipsPet insurance
Weight-loss programsGlasses and contact lenses
Vitamins and supplementsAnd much moreSlide18
Consumer Resources
Just search for “Anthem Blue Cross and Blue Shield” in Google PlayTM or the App Store® and download our app. You can:
Find a doctor, hospital, specialist or urgent care near you.Share, fax or email your ID card right from your smartphone.
Check your claims.Estimate your costs for care.
Take your benefits
with you
18Slide19
LiveHealth Online allows you to have face-to-face conversations with a doctor on your computer or mobile device
It’s especially convenient on nights and weekends when the clinic isn’t openAvailable anywhere you have a computer or mobile device with Internet access Provides access to in-network, board-certified doctors and licensed behavioral
health professionalsAllows doctors to ePrescribe** utilizing local pharmacies (where applicable)Costs $49 for an online doctor visit. They take payment
via Visa, MasterCard, American Express and Discover Is secure, convenient and easy to use
**In certain states, prescriptions cannot be issued as a result of an online interaction with a doctor.
For
state telehealth availability, check the map on
LiveHealth.com
.
LiveHealth
Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
LiveHealth
OnlineSlide20
OurHealth Clinics - FREE
Primary & Urgent Care
Physician-led clinics (
ages
6
+
)
Preventive care
Colds/flu
, sprained
ankle, rashes, etc.
Suture removal, wound care, minor
injuries
Health Pro Referrals
Wellness ServicesAnnual exams/physicalsOnline member portal for health tools/assessmentsMedications90 common acute/maintenance medicationsPrescriptions filled on-siteRequires visit with providerGeneral LabsOn-site general labHundreds of common blood/urine testsOutside lab orders allowed20Slide21
OurHealth Clinics
21
Schedule appointments:
Online
member.ourhealth.org
By phone
(866) 434-3255
At
the clinic
Reserved
times for urgent same-day appointments
Clinic
services
are FREE OF CHARGESlide22
Voluntary Life Insurance
EnrollmentThis is a one time enrollment period. If you wish to elect coverage, you must do so in 2017. There will be no future enrollment opportunities without carrier consent. No medical information will be requiredIf you are currently enrolled, you will need to re-enroll in this coverage
BenefitsVoluntary life benefits are available to employees in units of $10,000 up to a maximum of $200,000Guarantee issue of $200,000No change in rates
Spouse: Guarantee issue of $20,000 (employee must elect coverage)Children: maximum of $10,000 (employee must elect coverage)22Slide23
Open Enrollment will be from November 5 – 17 This is an ACTIVE enrollment, which means everyone who wants insurance must enroll!
Open Enrollment
23